Citation Nr: 20003302
Decision Date: 01/14/20	Archive Date: 01/14/20

DOCKET NO. 14-12 436
DATE: January 14, 2020

REMANDED

Service connection for asthma, including as secondary to service-connected posttraumatic stress disorder (PTSD) and depressive disorder with psychotic features, is remanded.

REASONS FOR REMAND

The appellant is a Veteran who served on active duty from August 1951 to July 1956.  These matters are before the Board of Veterans’ Appeals (Board) on appeal from a February 2011 rating decision. The Board previously remanded this case in September 2017.

1. Service connection for asthma, including as secondary to service-connected PTSD and depressive disorder with psychotic features, is remanded.

The prior remand asked for a medical opinion on whether the Veteran’s service-connected PTSD and depressive disorder cause or aggravate his asthma, but the March 2018 opinion received is conclusory, contains little to no rationale, and relies solely on a finding that “by definition, [these] are different diseases entities with different pathophysiological process unrelated to each other” without taking the time or effort to consider the possibility that his psychiatric symptoms (which can manifest as a wide range of physical reactions, including respiratory problems) might contribute to his asthma. This is particularly troubling considering the medical evidence and the Veteran’s 100 percent rating for psychiatric disability suggest that such condition causes near-continuous panic or depression.

The matters are REMANDED for the following action:

1. Obtain all updated records (i.e., those not already of record) of VA and adequately identified private treatment the Veteran has received for the disabilities remaining on appeal. 

2. Forward the Veteran’s file to a psychiatrist, pulmonologist, or other appropriate physician for a medical opinion on the likely cause of his asthma. Based on a review of the record, pertinent medical literature, and any other evidence (including but not limited to a separate physical examination if it would be helpful) the examiner must respond to the following:

(a.) Is it AT LEAST AS LIKELY AS NOT (A 50 PERCENT PROBABILITY OR GREATER) that the Veteran’s asthma is CAUSED BY OR PROXIMATELY DUE TO his service-connected PTSD and depressive disorder with psychotic features? The examiner must consider and discuss, among other possibilities, whether psychiatric symptoms contributed to the development of asthma.

(b.) Is it AT LEAST AS LIKELY AS NOT (A 50 PERCENT PROBABILITY OR GREATER) that the Veteran’s asthma is AGGRAVATED (WORSENED BEYOND ITS NATURAL PROGRESSION, REGARDLESS OF PERMANENCE) BY his service-connected PTSD and depressive disorder with psychotic features? The examiner must consider and discuss, among other possibilities, whether psychiatric symptoms contribute to the frequency or severity of asthma attacks.

All opinions must include a detailed rationale. Providing an opinion or conclusion without enough explanation will delay processing of the claim and require further clarification. 

 

 

VICTORIA MOSHIASHWILI

Veterans Law Judge

Board of Veterans’ Appeals

Attorney for the Board	M. Yuan, Counsel

The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.